Vascular factor dynamics in therapy for microangiopathy with underlying type 1 diabetes mellitus

Abstract

Background. The adverse impact of chronic hyperglycaemia on vascular wall in diabetes mellitus includes endothelial dysfunction with subsequent development of diabetic microangiopathy. Microangiopathy can be corrected via adequate glycaemic control for establishing a target level of glycated haemoglobin. Considering a multiplex nature of metabolic and vascular regulation, a comprehensive approach is required for simultaneous correction of rheological disorders, hypercoagulation and endothelial dysfunction.Objectives. Estimation of vascular factors (von Willebrand factor, desquamated endothelium, antithrombin III, protein C, VEGF) and capillaroscopic patterns in therapy for type 1 diabetes with methylethylpyridinol in comparison with sulodexide.Methods. A total of 89 patients with type 1 diabetes were examined and separated by two cohorts: 42 patients receiving sulodexide (cohort 1) and 47 patients receiving methylethylpyridinol (cohort 2). Therapy duration was 14 days. Both cohorts were estimated pre- and post-treatment endothelial conditions (activity of von Willebrand factor, VEGF, desquamated endothelial cell count), anticoagulant indicators (activity of antithrombin III, protein C) and had capillaroscopy with functional test and oximetry.Results. Diabetes patients in pre-treatment exhibited signs of endothelial dysfunction, reduced blood anticoagulant protection and capillary constriction. Both cohorts in post-treatment showed the significantly reduced von Willebrand factor, VEGF activity and desquamated endothelial cell count. The anticoagulant system revealed positive dynamics; capillaroscopy reported limiting of the capillary transition zonal diameter and a certain improvement in functional performance.Conclusion. Patients with type 1 diabetes were revealed with endothelial dysfunction and an increased blood procoagulant activity. Both sulodexide and methylethylpyridinol treatments improved endothelial dysfunction and anticoagulant blood protection. Both preparations can be used for complex microangiopathy correction in patients with <10-years history of type 1 diabetes mellitus.

Keywords

• diabetes mellitus
• endothelial dysfunction
• methylethylpyridinol
• sulodexide
• von willebrand factor
• microangiopathy